Individuals with advanced gastrointestinal (GI) cancers are often burdened by disease- and treatment[unreadable]related symptoms. In 2008, the projected estimates of incidence rates for common GI cancers such as colorectal, pancreatic, and hepatocellular carcinoma (HCC) is approximately 208,000 cases (1). Of these cases, more than 50% will die within one year (1). This poor prognosis is frequently coupled with multiple symptoms such as pain, fatigue, weight loss, and obstructive syndromes. When treatment intent is not curative, as in the case with advanced GI cancers, aggressive symptom management in a palliative care setting is of the utmost importance. Despite this fact, few symptom-related research explores the symptom experience of individuals with advanced GI cancers. Furthermore, behavioral factors such as illness perception and its impact on overall symptom distress have not been clearly defined in this highly vulnerable and understudied population. The specific aims are: 1) to describe illness perceptions as indicated in the five domains of the Common Sense Model (identity, timeline, consequences, cause, control) and their relationship to overall symptom distress in advanced GI cancers;2) to describe individual symptom severity and overall symptom distress;3) to describe pain, associated symptoms, and their relationship to overall symptom distressestions;and 4) to describe the relationship between sociodemographic, disease, and health status characteristics and overall symptom distress. The conceptual framework incorporates essential concepts in the Common Sense Model, specifically the five domains of illness perception, as well as current empirical evidence on symptom distress. A cross sectional, correlational design will be used to measure the relationships of illness perception, pain, and symptom distress in three GI cancers in the palliative care setting. Proposed assessment tools include Illness Perception Questionnaire, MSAS, and Brief Pain Inventory (BPI). Participants will complete the assessment tools in the ambulatory clinic following informed consent. This proposed study addresses the priority topic of advancing the science of palliative care in three cancer populations with high symptom burden. Findings will serve as preliminary data to aid in the development of an innovative palliative care nursing intervention aimed at reducing symptom distress in individuals with advanced GI cancers. Findings from this study will help in understanding the patient's symptom experience in colorectal, pancreatic, liver cancers. This information will help improve the treatment of these cancers, lower patient distress, and improve QOL.